Search PubMedSearch

Biomedical subjects

D M Clarke

Publications and source records attributed to D M Clarke.

At least 19 recordsLinked to original sources

The transmembrane domains of the human multidrug resistance P-glycoprotein are sufficient to mediate drug binding and trafficking to the cell surface.

The human multidrug resistance P-glycoprotein (P-gp) is organized in two tandem repeats with each repeat consisting of an N-terminal hydrophobic domain containing six potential transmembrane segments followed by a hydrophilic domain containing a nucleotide-binding fold. A series of deletion mutants together with an in vivo drug-binding assay were used to test whether the deletion mutants interacted with substrates or were transported to the cell surface. We found that a deletion mutant consisting of only the transmembrane domains (residues 1-379 plus 681-1025) retained the ability to interact with drug substrates. In the absence of drug substrates, the deletion mutant was sensitive to trypsin and endoglycosidase H. Expression in the presence of verapamil, vinblastine, capsaicin, or cyclosporin A, however, resulted in a mutant protein that was resistant to trypsin and endoglycosidase H. The mutant was then detected at the cell surface and was sensitive to digestion by endoglycosidase F. By contrast, the N-terminal transmembrane domain (residues 1-379) alone did not interact with drug substrates, since it was sensitive to only endoglycosidase H and was not detected at the cell surface. These results show that the nucleotide-binding domains are not required for interaction of P-gp with substrate or for trafficking of P-gp to the cell surface.

ATP Binding Cassette Transporter, Subfamily B, Mem

The glycosylation and orientation in the membrane of the third cytoplasmic loop of human P-glycoprotein is affected by mutations and substrates.

Multiple topologies have been detected for the COOH-terminal half of the human multidrug resistance P-glycoprotein (P-gp). In one topology, the predicted third cytoplasmic loop (CL3) is on the cytoplasmic side (P-gp-CL3-cyt) of the membrane. In an alternate topology, CL3 is on the extracellular side of the membrane (P-gp-CL3-ext). It is not known if both forms of P-gp are active because it is difficult to distinguish either topology in the full-length molecule. When the halves of P-gp are expressed as separate polypeptides, the two topologies of the C-Half are readily distinguished on SDS-PAGE, because only the C-Half (CL3-ext) is glycosylated. To test whether both topologies can fold into an active enzyme, we assayed for interaction between the N- and C-Halves of P-gp since functional P-gp requires interaction between both halves. In a mutant P-gp (E875C) that gave about equal amounts of both topologies, only the C-Half (CL3-cyt) could be recovered by nickel chromatography after coexpression with the histidine-tagged N-Half P-gp. The isolated N-Half and E875C C-Half (CL3-cyt) polypeptides, when expressed together, exhibited verapamil- and vinblastine-stimulated ATPase activities that were similar to the wild-type enzyme. We also found that biosynthesis of mutant E875C C-Half in the presence of the N-Half P-gp resulted in enhanced expression of C-Half (CL3-cyt). By contrast, interaction of C-Half (CL3-ext) with N-Half P-gp was not detected. These results show that the topology of the C-Half portion of P-gp greatly influences its interactions with the amino-terminal half of the molecule.

ATP Binding Cassette Transporter, Subfamily B, Mem

Psychological factors in nutritional disorders of the elderly: part of the spectrum of eating disorders.

OBJECTIVE: To illustrate common psychogenic factors involved in undereating and undernutrition in the elderly. METHOD: Two cases are described. RESULTS: In the context of age-related physical and social factors, obsessional, phobic, and hypochondriacal anxieties can lead to significant food restrictions and undernutrition. DISCUSSION: Psychogenic factors need to be considered in undernutrition of the elderly and the phenomena considered in the spectrum of eating disorders.

Aged

How is psychiatry taught to Australian and New Zealand medical students?

OBJECTIVE: This study aimed to describe the amount, format and content of psychiatry teaching programs in all 12 Australian and New Zealand medical schools. METHOD: A structured questionnaire which included definitions and coding instructions was completed by class coordinators for the years of 1995 or 1996. Missing and inconsistent data were checked by coordinators and results were confirmed by heads of department. RESULTS: Most departments of psychiatry taught throughout the undergraduate course. Only three made no contribution to pre-clinical teaching. The time devoted to clinical tuition ranged from 279 to 454 h per university with a mean of 353 h. Clinical attachments occupied most time (mean = 70%), followed by small group teaching (mean = 19%) and lectures (mean = 11%). Medical schools varied greatly in the attention given to history taking and mental state examination, psychological therapies and the sub-specialties of child and aged psychiatry. Clinical attachments were mostly to adult inpatient units. Private psychiatric hospitals and clinics were used infrequently as were consultation-liaison psychiatry services and primary care. CONCLUSION: There is a need to broaden the clinical experience of students to better equip them for future medical practice. There appears to be a serious mis-match between the settings in which most students are taught and the settings in which most will work later as non-psychiatric practitioners. It was disappointing that psychological therapies received so little attention given the central place of counselling in modern medical practice.

Adult

Measuring the quality of supervision and the training experience in psychiatry.

OBJECTIVE: The aim of this study was to develop and trial a method of trainee evaluation of the supervision and training experience. METHOD: A questionnaire was developed and applied at the end of each of four 6-month clinical rotations. RESULTS: The evaluation demonstrated areas of strength (punctuality and reliability, encouragement, educational value, clinical guidance) and weakness (journal club, clinical meetings). Many supervisors were not observing diagnostic or management interviews of trainees. Psychotherapy supervision received the highest ratings. CONCLUSIONS: Because of the privacy of supervision and the occasional nature of evaluations, reliability of scores cannot be demonstrated. However, within the context of a model of quality improvement, and supplemented by the education and supervision of supervisors, trainee evaluations can be useful in targeting specific areas of deficiency in training and supervision.

Education

Sex, honesty and the supervisory relationship: a response to Ryan.

OBJECTIVE: An argument has been presented in this journal for a generally permissive attitude to consensual sexual relations between psychiatrists and trainee psychiatrists except in circumstances where there is a direct supervisory relationship. This paper challenges that view. METHOD: The arguments are reviewed. A developmental perspective of training is used to show that the autonomy of trainees is restricted in a manner similar to a student in relation to a teacher. This confers on psychiatrists a duty of care. RESULTS: On the basis of respect for autonomy, the strength of argument for a prohibition on consensual sexual relationships is strong for a young trainee, and weakens as a person proceeds through training and approaches the status of a colleague. A policy of restraint would facilitate the development of a general atmosphere of trust, which is an important requirement for good supervision and the basis of professional relationships. An ethical judgement cannot be made, however, without the consideration of other relationships and commitments existing outside the supervisory relationship for each person involved. CONCLUSIONS: In order to create a secure and unambiguous training environment that maximises trust, a general principle of prohibition on sexual relationships between psychiatrists and trainees is preferred, although circumstances exist where such relationships are not unethical.

Ethics, Medical

The human multidrug resistance P-glycoprotein is inactive when its maturation is inhibited: potential for a role in cancer chemotherapy.

The human multidrug resistance P-glycoprotein (P-gp) contributes to the phenomenon of multidrug resistance during cancer and AIDS chemotherapy. A potential novel strategy to circumvent the effects of P-gp during chemotherapy is to prevent maturation of P-gp during biosynthesis so that the transporter does not reach the cell surface. Here we report that immature, core-glycosylated P-gp that is prevented from reaching the cell surface by processing mutations or by proteasome inhibitors such as lactacystin or MG-132 exhibited no detectable drug-stimulated ATPase activity. Disulfide cross-linking analysis also showed that the immature P-gp did not exhibit ATP-induced conformational changes as found in the mature enzyme. In addition, the immature P-gp was more sensitive to trypsin than the mature enzyme. These results suggest that P-gp is unlikely to be functional immediately after synthesis. These differences in the structural and enzymatic properties of the mature and core-glycosylated, immature P-gp could potentially be used during chemotherapy, and should result in the search for compounds that can specifically inhibit the maturation of P-gp.

ATP Binding Cassette Transporter, Subfamily B, Mem

Merck Frosst Award Lecture 1998. Molecular dissection of the human multidrug resistance P-glycoprotein.

The human multidrug resistance P-glycoprotein is an ATP-dependent drug pump that extrudes a broad range of cytotoxic agents from the cell. Its physiological role may be to protect the body from endogenous and exogenous cytotoxic agents. The protein has clinical importance because it contributes to the phenomenon of multidrug resistance during chemotherapy. In this review, we discuss some of the results obtained by using molecular biology and protein chemistry techniques for studying this important and intriguing protein.

ATP Binding Cassette Transporter, Subfamily B, Mem

Quality control by proteases in the endoplasmic reticulum. Removal of a protease-sensitive site enhances expression of human P-glycoprotein.

Human P-glycoprotein is synthesized in HEK 293 cells as two major products: the 150-kDa core-glycosylated intermediate and the 170-kDa mature proteins. The 150- and 170-kDa proteins were not detected in mutants such as G341C. The major protein in this mutant was a 130-kDa proteolytic degradation product. This result suggested that the mutant protein was misfolded and sensitive to proteolytic digestion during or immediately after synthesis. We found that mutation of Arg113, located in the first extracellular loop of P-glycoprotein and near the consensus glycosylation sites, to Ala, Lys, Glu, Met, or Cys blocked formation of the 130-kDa product. Introduction of R113A into mutant G341C resulted in the synthesis of a mature (170 kDa) and functional transporter. Similarly, when R113A was introduced into misprocessed mutants, there was increased synthesis of the 150-kDa core-glycosylated intermediate. Maturation of the core-glycosylated intermediate into the mature enzyme, however, was not observed. These results suggest that polytopic proteins are accessible to proteases in the lumen of the endoplasmic reticulum during biosynthesis and that proteases are important contributors to the quality control mechanism involved in protein folding. It is also shown that unstable proteins can be made more stable by removal of hypersensitive proteolytic sites.

ATP Binding Cassette Transporter, Subfamily B, Mem

Psychological factors in illness and recovery.

To review evidence that psychological factors affect the course of physical illness three areas are examined: epidemiological evidence showing the levels of psychiatric disturbance co-morbid with physical illness; health services research showing the burden of disease and care associated with this co-morbidity; randomised, controlled trials of psychological interventions in cancer, myocardial infarction and irritable bowel syndrome. There is substantial psychiatric co-morbidity with physical illness which is associated with increased disability, mortality and utilisation of health-care resources (primary care visits, hospitalization, length of hospital stay, cost). A small number of controlled intervention studies have shown the efficacy of psychological interventions to prolong survival in cancer and myocardial infarction, and to improve symptomatology in irritable bowel syndrome and other chronic somatizing conditions. Psychological factors do significantly affect outcomes of physical illness. The role of psychological treatments, alongside somatic therapies, needs further study.

Colonic Diseases, Functional

Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey.

OBJECTIVE: To determine the prevalence of psychological morbidity and describe quality of life in women with early-stage breast cancer. DESIGN: Cross-sectional descriptive study (3 months after conservative breast surgery or mastectomy) of patients from nine general hospitals in Melbourne, Victoria, October 1994 to March 1997. PARTICIPANTS: 303 women with early-stage breast cancer entering a randomised trial of adjuvant psychological group therapy; mean age, 46 years (SD, 8). MAIN OUTCOME MEASURES: Diagnostic and Statistical Manual of Mental Health (DSM)-IV psychiatric diagnoses generated by the Monash Interview for Liaison Psychiatry; quality-of-life data based on the the European Organization for Research and Treatment of Cancer quality-of-life questionnaire (QLQ)-C30 (core) and QLQ-BR23 (breast module) instruments. RESULTS: 45% of the women (135/303) had a psychiatric disorder; 42% (127) of the sample had depression or anxiety, or both; there was minor depression in 82 (27.1%), an anxiety disorder in 26 (8.6%), major depression in 29 (9.6%) and a phobic disorder in 21 (6.9%). 20% of women (61) had more than one disorder. On quality-of-life measures nearly one-third of the women felt less attractive and most had lost interest in sexual activity. There was substantial distress about hair loss. Symptoms of lymphoedema were described by 13 women (4.3%). Breast conservation surgery was associated with a better body image (P<0.01). CONCLUSION: Women recently diagnosed with early-stage breast cancer have high rates of psychiatric and psychological disturbance. Quality of life is substantially affected. Clinicians should actively explore their patients' psychological adjustment to enable early recognition and treatment of these disorders.

Adaptation, Psychological

Nonylphenol ethoxylates, but not nonylphenol, are substrates of the human multidrug resistance P-glycoprotein.

Alkylphenol ethoxylates are surfactants that are commonly used in industry and in home care products. They are broken down by anaerobes to yield toxic environmental pollutants such as nonylphenol. In this study, we tested whether nonylphenol ethoxylates and their most common biodegradation product, nonylphenol, were substrates of human P-glycoprotein. In vivo and in vitro assays showed that the enzyme interacts with a wide variety of nonylphenol ethoxylate compounds, but not with nonylphenol. These results suggest that P-glycoprotein can protect organisms from the toxic and estrogenic effects of nonylphenol ethoxylates, but not from the major biodegradation product, nonylphenol.

ATP Binding Cassette Transporter, Subfamily B, Mem

Superfolding of the partially unfolded core-glycosylated intermediate of human P-glycoprotein into the mature enzyme is promoted by substrate-induced transmembrane domain interactions.

Misprocessed mutants of human P-glycoprotein accumulate as core-glycosylated intermediates in the endoplasmic reticulum and are rapidly degraded. Trypsin digestion was used to test for structural differences between mature and core-glycosylated forms of P-glycoprotein. We found that the core-glycosylated wild-type and mutant P-glycoproteins were both 100-fold more sensitive to trypsin compared with the mature form of the wild-type enzyme. This result suggested that the core-glycosylated forms of both wild-type and mutant P-glycoproteins have similar unfolded structures, whereas the mature enzyme is folded into a more compact structure. The core-glycosylated mutant P-glycoproteins could be converted to the mature trypsin-resistant form by synthesis in the presence of drug substrate. Addition of proteasome inhibitor MG-132 to stabilize the core-glycosylated intermediate resulted in the accumulation but not maturation of the mutant protein. Further analysis showed that the second transmembrane domain TMD2 also became more resistant to trypsin digestion only after coexpression with TMD1 in the presence of substrate. Taken together, these results suggest that simply stabilizing the core-glycosylated intermediate is not sufficient to promote maturation of the processing mutants and that drug substrates induce maturation by promoting superfolding of the transmembrane domains.

ATP Binding Cassette Transporter, Subfamily B, Mem

Non-ACTH POMC fragments stimulate aldosterone production by human adrenal cells in vitro.

The possibility that non-ACTH proopiomelanocortin-derived fragments may stimulate aldosterone production has previously been studied using nonhuman cells with inconsistent results. We have examined the response of aldosterone to beta-endorphin (beta-End) and joining peptide (JP) and compared these with the response to ACTH using eight cell suspensions prepared from human adrenal glands. ACTH, 10(-6), 10(-8), and 10(-10) M, consistently stimulated aldosterone accumulation above that occurring in unstimulated cells (150 +/- 83, 120 +/- 62, and 77 +/- 32 fmol/10(4) cells above basal, respectively; mean +/- SE; p < 0.05). beta-End significantly stimulated aldosterone production at 10(-6) and 10(-8) M (114 +/- 84 and 50 +/- 24 fmol/10(4) cells above basal; p < 0.05); 10(-10) M beta-End did not provide significant stimulation. Furthermore, JP stimulated aldosterone biosynthesis (41 +/- 16 fmol/10(4) cells above basal; p < 0.05), only at the highest concentration used, 10(-6) M. The addition of 10(-8) M ACTH plus 10(-6) and 10(-10) M beta-End to human adrenal cells yielded values significantly greater than those achieved with either agent alone (267 +/- 152 and 183 +/- 89 fmol/10(4) cells above basal; p < 0.05). These data indicate for the first time that beta-End and JP have the capacity to stimulate aldosterone production in human adrenal cells in vitro. The physiological and potential clinical significance of these observations has yet to be elucidated.

Adrenal Glands

Identification of residues in the drug-binding site of human P-glycoprotein using a thiol-reactive substrate.

We identified a thiol-reactive compound, dibromobimane (dBBn), that was a potent stimulator (8.2-fold) of the ATPase activity of Cys-less P-glycoprotein. We then used this compound together with cysteine-scanning mutagenesis to identify residues in transmembrane segment (TM) 6 and TM12 that are important for function. TM6 and TM12 lie close to each other in the tertiary structure and are postulated to be important for drug-protein interactions. The majority of P-glycoprotein mutants containing a single cysteine residue retained substantial amounts of drug-stimulated ATPase activity and were not inhibited by dBBn. The ATPase activities of mutants L339C, A342C, L975C, V982C, and A985C, however, were markedly inhibited (>60%) by dBBn. The drug substrates verapamil, vinblastine, and colchicine protected these mutants against inhibition by dBBn, suggesting that these residues are important for interaction of substrates with P-glycoprotein. We previously showed that residues Leu339, Ala342, Leu975, Val982, and Ala985 lie along the point of contact between helices TM6 and TM12, when both are aligned in a left-handed coiled coil (Loo, T. W., and Clarke, D. M. (1997) J. Biol. Chem. 272, 20986-20989). Taken together, these results suggest that the interface between TM6 and TM12 likely forms part of the potential drug-binding pocket in P-glycoprotein.

ATP Binding Cassette Transporter, Subfamily B, Mem

Disease-associated mutations in cytoplasmic loops 1 and 2 of cystic fibrosis transmembrane conductance regulator impede processing or opening of the channel.

Since little is known about the contribution to function of the N-terminal cytoplasmic loops (CL1, residues 139-194; CL2, residues 242-307) of cystic fibrosis transmembrane conductance regulator (CFTR), all nine point mutations identified in CLs 1 and 2 from patients with cystic fibrosis were reconstructed in the expression vector pcDNA3-CFTR and expressed transiently in COS-1 and HEK-293 cells and stably in Chinese hamster ovary (CHO) cells. Four amino acid substitutions retarded production of mature, fully glycosylated CFTR, suggesting that misprocessing of the channel causes the disease symptoms in the affected patients. Protein maturation could not be promoted by cell culture conditions of reduced temperature (26 degrees C). When properly processed mutants were evaluated for functional defects by the iodide efflux method, the G178R- and E193K-CFTR-expressing cell lines showed impaired anion translocation activities. Patch-clamp studies of single channels revealed that E193K variants had a significantly decreased open probability, which resulted from an increase in the mean closed time of the channels. This contrasted with a previous study of disease-associated point mutations in CL3 that mainly affected the mean open time. None of the maturation-competent CL 1 and 2 mutants had altered conductance. Thus, the N-terminal CLs appear not to contribute to the anion translocation pathway of CFTR; rather, mutations in CL1 can impede transition to the open state. Interestingly, the ability of the non-hydrolyzable ATP analogue adenylyl imidodiphosphate (AMP-PNP) to lock the channel into open bursts was abolished by the I148T and G178R amino acid substitutions.

Adenylyl Imidodiphosphate